Question:
Dr. Ellner or Dr. Welker & Aetna POS Insurance Cost/Pmts

Hello... I've been calling for days to try and get some answers about what I should expect the insurance company to pay. I am on the Aetna US Healthcare, Managed Choice POS plan in Oregon. I have a referral from my PCP to consult and have the surgery with Dr. Julie Ellner in San Diego. I even have a date. I'm also considering Dr. Welker in Eugene, OR. The insurance company even approved it, but when I ask what one will charge and the other will pay, I get the full range of answers -- and no one will provide anything in writing. To top it off, I'm currently collecting unemployment paying the COBRA fees, so I can't really afford a big out-of-pocket expense right now. Can anyone help me understand what the total cost (Surgeon, Hospital, Anesthesiologist, etc, etc.) will cost with Dr. Ellner at Alvarado (or Dr. Welker) and what Aetna USHC/POS will pay. Thanks for any help you could provide. Regards, Miguel    — Miguel C. (posted on November 16, 2001)

November 16, 2001
Hi. I had Aetna USHC MC when I had my surgery. My surgery was paid for 100%. I made sure it was approved and also that my surgeon was approved as if it was he was IN NETWORK. He isn't in network, but they have a policy that if you don't have a surgeon within like 50 miles of your home...then you can chose an out of network surgeon and it will be paid for as if they are in network. I didn't have to pay anything for my WLS. I would keep calling to get answers...ask to talk to supervisors if you have to. But that is what happened in my case. GOOD LUCK! Feel free to email me.
   — Nicole P.

November 21, 2001
I will have surgery at Alvarado. I don't have the full scoop yet. I will have to pay $7800 up front, with most of that going to the surgeon, and $1000 or so going to the assistant surgeon. It's because Ellner/ Clark/ Wittgrove are not part of any network. ( But I do believe they are the best!!!) That should cover my fees, as my ppo will cover the remainder. As for the hospital, they are on the PPO list, so I only pay 20%. My insurance company sent a form to the DR.asking exactly what the billing breakdown would be so that my insurer could tell me what my fees will be. I am still waiting to get info back. If you were a cash patient, you could get an estimate. With insurance, the Doctors never really know what they are going to be paid in the end. So, I don't blame them for not nailing down a figure, although it's frustrating for people like us. I have heard this story from many WLS patients. I hope that you find the info you are seeking. If you do have the opportunity to switch insurers, do your research and pick an HMO that covers WLS ( they can't deny pre existing conditions.) Good Luck to you!
   — [Anonymous]